Groeneveld Peter W, Matta Mary Anne, Suh Janice J, Heidenreich Paul A, Shea Judy A
Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
Am J Cardiol. 2006 Nov 15;98(10):1409-15. doi: 10.1016/j.amjcard.2006.06.041. Epub 2006 Oct 4.
Although the clinical efficacy of implantable cardioverter-defibrillators (ICDs) has been convincingly demonstrated in clinical trials, the impact of ICDs on health care costs and recipients' quality of life (QOL) is less certain. The existing medical research on the health care costs and QOL effects of ICDs was reviewed and summarized. Medline and the Institute for Scientific Information's Web of Knowledge were searched for publications reporting costs of care and QOL assessments of ICD recipients. Unpublished and non-peer-reviewed "gray" publications were excluded. Reports were included if they reported primary, original patient data that were collected after 1993, when nonthoracotomy defibrillators entered clinical practice. Two reviewers independently evaluated publications for relevance and quality, abstracted study data, and summarized the findings. Excessive heterogeneity among studies prevented formal meta-analysis, so a narrative synthesis was performed, and key themes were identified from the published research. There were limited published data on the costs of ICD care, especially for the primary prevention of sudden cardiac death. The published research on ICD QOL lacked large, multicenter, longitudinal studies. Many ICD QOL studies were performed in small numbers of patients at single centers. Initial ICD implantation costs ranged (in 2006 United States dollars) from $28,500 to $55,200, with annual follow-up costs ranging from $4,800 to $17,000. QOL was higher for ICD recipients than for patients treated with antiarrhythmic drugs, but there was a substantial prevalence of anxiety, depression, and "loss of control" in ICD recipients, particularly in those who had received ICD shocks. In conclusion, ICD implantation remains costly but may be becoming less expensive over time, and ICD recipients' QOL is significantly affected by their devices.
尽管植入式心脏复律除颤器（ICD）的临床疗效已在临床试验中得到令人信服的证明，但其对医疗保健成本和接受者生活质量（QOL）的影响尚不确定。对现有的关于ICD医疗保健成本和生活质量影响的医学研究进行了综述和总结。检索了Medline和科学信息研究所的《知识网络》，以查找报告ICD接受者护理成本和生活质量评估的出版物。未发表和未经同行评审的“灰色”出版物被排除在外。如果报告包含1993年非开胸除颤器进入临床实践后收集的原始患者数据，则纳入报告。两名评审员独立评估出版物的相关性和质量，提取研究数据，并总结研究结果。研究之间存在过多的异质性，无法进行正式的荟萃分析，因此进行了叙述性综合分析，并从已发表的研究中确定了关键主题。关于ICD护理成本的已发表数据有限，尤其是在心脏性猝死的一级预防方面。关于ICD生活质量的已发表研究缺乏大型、多中心的纵向研究。许多ICD生活质量研究是在单个中心的少数患者中进行的。最初的ICD植入成本（以2006年美元计）在28,500美元至55,200美元之间，每年的随访成本在4,800美元至17,000美元之间。ICD接受者的生活质量高于接受抗心律失常药物治疗的患者，但ICD接受者中焦虑、抑郁和“失控感”的患病率相当高，尤其是那些接受过ICD电击的患者。总之，ICD植入仍然成本高昂，但随着时间的推移可能会变得不那么昂贵，并且ICD接受者的生活质量受到其设备的显著影响。
